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Mon, 21 Jan 2019 17:22:10 +0000en-GBhourly1https://wordpress.org/?v=4.9.9Ideology or Evidence (part two)? The battle over abortion statisticshttps://cmfblog.org.uk/2017/08/02/ideology-or-evidence-part-two-the-battle-over-abortion-statistics/
https://cmfblog.org.uk/2017/08/02/ideology-or-evidence-part-two-the-battle-over-abortion-statistics/#respondWed, 02 Aug 2017 09:59:25 +0000https://www.cmfblog.org.uk/?p=11631Having blogged about the triumph of ideology over evidence in relation to the campaign in England, Scotland and Northern Ireland for presumed consent to organ donation, I can now report on a campaign where evidence triumphed over ideology.

This one is in relation to the reporting and publicity of abortion outcomes.

To give some background: in January this year an organisation in Northern Ireland, Both Lives Matter, reported that an estimated 100,000 people are alive today in Northern Ireland because of the restrictive law on abortion there, compared to what would have happened if the far less restrictive 1967 Abortion Act had been passed there. In fact they say that is a conservative estimate.

This 100,000 lives statistic received a great deal of media publicity, including billboard advertisements that highlighted it. However the figure was challenged through complaints to the Advertising Standards Agency arguing that the billboard was ‘inappropriate, inaccurate and offensive’. Both Lives Matter received a letter from the ASA outlining the complaint and launching an investigation into the billboard.

I’m sure many people assumed the figure was indeed an exaggeration and an ideological campaigning tool. However, five months later the ASA Executive completely vindicated the billboard claim.

‘On balance, we concluded that the evidence indicated that there was a reasonable probability that around 100,000 people were alive in Northern Ireland today who would have otherwise been aborted had it been legal to do so.’

So instead of ‘100,000 lives lost’ being a figure based on ideology, it was upheld – independently – as fact, and correspondingly it was the complainants to these facts who were exposed as following ideology not evidence.

The 100,000 figure also shows that criminal laws against abortion do in fact save lives. This is timely in view of the current campaign to decriminalise abortion (remove all legal restrictions on abortion), and to help challenge fallacious arguments such as the comments of Justice Horner in the High Court that: ‘There is no evidence before this Court…that the law in Northern Ireland has resulted in any reduction in the number of abortions obtained by Northern Irish women.’ [Paragraph 142].

I guess if one does not believe that a life is lost through abortion, then such figures are beyond comprehension. Yet in reality, one in ten people under fifty are alive because of the law in Northern Ireland. This number could fill their national football stadium five times over. Each one a precious, valuable human being, alive today.

What a contrast to the 8 million lives lost in England and Wales to abortion since 1967. And what a challenge to us all because, as Dawn McAvoy, from Both Lives Matter says:

‘Whatever your view on abortion, there are 100,000 reasons to pause and ask some big questions about where our culture is going.’

]]>https://cmfblog.org.uk/2017/08/02/ideology-or-evidence-part-two-the-battle-over-abortion-statistics/feed/0Doctors strike back at BMJ editors over assisted suicide stancehttps://cmfblog.org.uk/2014/07/05/doctors-strike-back-at-bmj-editors-over-assisted-suicide-stance/
https://cmfblog.org.uk/2014/07/05/doctors-strike-back-at-bmj-editors-over-assisted-suicide-stance/#respondSat, 05 Jul 2014 17:52:50 +0000https://www.cmfblog.org.uk/?p=9929BMJ editors Fiona Godlee and Tony Delamothe are long-time supporters of decriminalising assisted suicide and have frequently used their editorial position in Britain’s most widely read medical journal to advance their cause.

This week they have written an editorial in support of Lord Falconer’s Assisted Dying bill which has understandably received a lot of media coverage (see here, here and here) and has got the blogosphere buzzing (see here, here, here and here).

They argue that assisted dying should be legalised because respecting ‘choice’ (autonomy) is now a more important priority than preserving life.

The BMJ is editorially independent from the British Medical Association (BMA) but is paid for by the subscriptions of BMA members, most of whom do not support changing the law.

So it is not surprising that their editorial has generated a lot of correspondence, almost all of it opposing Godlee and Delamothe.

Dr Mark Porter, chairman of the BMA council has said:

‘There are strongly held views within the medical profession on both sides of this complex and emotive issue.

The BMA remains firmly opposed to legalising assisted dying. This issue has been regularly debated at the BMA’s policy forming annual conference and recent calls for a change in the law have persistently been rejected.

The BMJ is a wholly owned subsidiary of the BMA, and quite rightly has editorial independence. Its position on assisted dying is an editorial decision and does not reflect the views of the BMA or the medical profession. Our focus must be on making sure every patient can access the very best of palliative care, which empowers patients to make decisions over their care.’

A letter in the same print edition (so received before the editorial was published) from RCGP Council Chair Maureen Baker makes clear that the recent RCGP consultation on ‘assisted dying’ was comprehensive and conclusively in favour of no change to the law.

‘Our recent consultation on assisted dying was one of the most comprehensive ever undertaken, with 1700 members responding from all four nations of the UK.

The result was conclusive—77% of members who submitted responses directly to the college indicated that the RCGP should maintain its opposition to a change in the law.

Of the 28 RCGP bodies and groups who responded, 20 reported a majority view in favour of maintaining the college’s opposition to a change in the law and three reported a majority view in favour of a “neutral” stance. None reported a majority view in favour of active support for a change in the law.’

There is also an excellent onhealthy avapro contribution, again the same print edition, from Rob George, professor of palliative care, Cicely Saunders Institute, King’s College London.

In an article titled ‘We must not deprive dying people of the most important protection’ he argues that the safety of vulnerable people must take priority over the determined wishes of individuals. Hard cases are already dealt with mercifully under the law which does not need changing.

‘Elizabeth Butler-Sloss, former president of the High Court, said, “Laws, like nation states, are more secure when their boundaries rest on natural frontiers. The law that we have rests on just such a frontier . . . The law is there to protect us all. We tinker with it at our peril.”

For me the real question is this: “Which is worse: not to kill people who want to die or to kill people who might want still to live?” In my experience it is impossible to separate those who might want to die from those who believe they ought to die and whose view is pretty well never “settled.” No one can be sure that some people not now at risk will find themselves so were the law to change.

A full blooded expression of autonomy includes the responsibility at times to restrain oneself on behalf of another: when it comes to having our lives ended, let’s keep it that way. Once this line is crossed there is no going back.’

I was briefly quoted in the Telegraph making much the same point about the limits of autonomy:

‘While autonomy is important it has to be balanced against other principles including public safety.

None of us believes autonomy is absolute, if we did we would have to say that there was no place for law because every single law restricts personal autonomy.’

Godlee and Delamothe appear not to understand that autonomy has limits. They are also well out of step with medical opinion and do not speak for the medical profession.

About two thirds of doctors in most surveys are opposed to any change in the law along with all the major medical institutions including the BMA, RCGP, RCP, British Geriatric Society and the Association for Palliative Medicine.

In a free society choice is important, but it has its limits. The duty to protect life trumps the so-called ‘right to die’.

They also examine a number of claims made by proponents of legalised physician-assisted suicide and conclude that they fail to stand up to serious scrutiny

“The law”, the Peers write, “accurately and conscientiously reflects the perceptions which as a society we have of suicide – that, while those who attempt to take their own lives should not be punished, suicide itself should not be encouraged or assisted”.

They point to the strenuous efforts, including ‘suicide watches’ and suicide prevention strategies, which are taken to avoid suicides. “What the advocates of ‘assisted dying’ are saying, in effect, is that for some people we should put this process into reverse and facilitate their suicide”

The authors – Lord Brennan QC, The Rt Hon Baroness Butler-Sloss GBE and Lord Carlile QC CBE – observe that “the law’s combination of deterrence with discretion means that the incidence of illegal action is small and generally of a nature where prosecution is not necessary”

They reject the argument, sometimes advanced by proponents of legalised assisted suicide, that infrequency of prosecution means that the law is not working. “On the contrary”, they argue, “it indicates that it is working as it should. The effectiveness of a law is not measured by the number of prosecutions brought under it. An important consideration is its effectiveness in deterring the offence in question from happening at all”

The Suicide Act is not, they conclude, an oppressive law: “it is a law with a stern face but an understanding heart”

Lord Falconer’s Private Member’s Bill, the Peers write, “proposes no mere amendment of the law but a fundamental change to it. It is asking Parliament to agree that it should be lawful for some people to involve themselves in deliberately bringing about the deaths of others”.

Moreover, they observe, the bill contains no safeguards – beyond stating basic eligibility criteria – governing the assessment of requests for physician-assisted suicide. It leaves these crucial questions to be decided by others after Parliament has approved the bill. “As it stands”, the Peers write, “the bill is asking Parliament to sign a blank cheque”.

Commenting on the notion that the House of Lords should focus on the principle behind the bill and leave its practicalities to others, the Peers observe that “as legislators we have a duty to satisfy ourselves that any laws we enact will work in practice and will not put vulnerable people at risk of harm. Of course the House must consider the principle of the bill. But we should not forget that public safety is itself a key principle of legislation: it cannot be offloaded onto others”.

On Monday 25 February final year medical students were expecting to hear from the UK Foundation Programme Office (UKFPO) about their Foundation Year placements. The information was sent out – but on Tuesday, the Medical School’s Council (MSC) alerted the UKFPO that there had been a ‘potential scanning error with the Situational Judgement Test answer sheets’. On Wednesday UKFPO issued a statement to say:

‘Each UK medical school has been asked to arrange for their own students’ answer sheets to be checked to ensure total accuracy of the recorded answers. MSC will check the answer sheets for non-UK applicants…’

Applicants were advised not to act on the information provided to them on Monday, 25 February and the UKFPO added:

‘Applicants will be able to login to FPAS and see their final SJT score and allocation results at 9.00 am on Friday 8 March 2013.’

Liz McClenaghan, a CMF student member in Brighton and CMF Student Council chair, writes:

After originally applying for our foundation jobs in October 2012, the long awaited day arrived: on Monday 25 February we were to find out where God wanted us for the next two years. And just like clockwork, we did: Stability at last! We can start to plan our future again instead of just having to ‘trust. Now I can get excited about next year!

Even if our deanery allocation was disappointing, there was at least a certainty about having a job (or knowledge of the reserve list).

But, by Tuesday evening we were informed that there has been a mistake and it will be another ten days until we find out. If Facebook and Twitter are anything to go by then most medical students met this news with rage, disappointment and furthered anxiety.

And yet, while unexpected, as Christians we can be assured that God allowed this to happen for a reason. Whether that reason is for certain lessons to be learned on an institutional level, or a personal one, it gives us the opportunity to trust God further with our future. However chaotic our current situation, we have a great high priest who has gone before us, (Hebrews 4:14-16) to fix us to our unchanging God.

‘We have this as a sure and steadfast anchor of the soul, a hope that enters into the inner place behind the curtain, where Jesus has gone as a forerunner on our behalf, having become a high priest forever after the order of Melchizedek.’ (Hebrews 6:19-20 ESV)

So I implore you, over these next ten days of waiting, put your trust in the Lord again: the one who cares for us more than we can imagine; the one who reigns over all authorities; the one who scripted the entirety of our lives (…including the last 48 hours!).

I look forward to finding out where God has put me (second time round) because I know that while it might not be MY first choice, it is God’s first choice for my life. And wherever that is, he is preparing the way for me already!

Valentine’s day; Superbowl; Waitangi day; National Bird-Feeding Month… but of course the main event to note is the CMF National Student Conference! Preceded by the International Medical Students Conference (IMSC) it’s one of the highlights of the CMF year.

Delegates came from far and near. For the IMSC (3-10 February) we welcomed 27 students and doctors from as far a field as Russia and Brazil, as well as mainland Europe. Session topics included medical ethics, discipleship and practical wisdom for setting up and cultivating their own local and national Christian medical groups. All this was punctuated with plenty of opportunities to make new friends, see London (picture below), and generally have a great time.

More than 350 students (including those from IMSC) came to The Hayes in Swanwick over the weekend of 8-10 February via various methods of transport and even more varied arrival times, notwithstanding some terrible traffic delays.

The main Bible talks were led by Jason Clarke (pictured, right), reading and studying from Luke 12. You can listen to the first two talks on our CMF Soundcloud feed here. (We will be writing more about Jason’s talks in the next edition of our student journal, Nucleus.)

Former CMF Chairman Dr Nick Land spoke on leadership in the NHS for the annual Conference Address.

Seminars covered healing, creation and evolution, homosexuality, international mission and how to survive your foundation years to name just a few.

We worshipped, we studied God’s word, we asked questions, we broke bread together, we made friends, we were inspired, equipped, encouraged, we learnt what it means to live and speak for Jesus in medicine – we did CMF.

Here’s a selection of comments about the conference from those who attended:

Great weekend that I think every Christian medic should go to! Thanks so much!

An awesome weekend.

Thank you for a wonderful weekend again! God is so good & CMF is such a blessing!

A study released today by the Center for Addictions Research of British Colombia has found that a 10% increase in minimum per unit pricing of alcohol has led to a 32% drop in alcohol related mortality in two Canadian Provinces. Furthermore, the increase in price seems to have reduced alcohol consumption (and related health problems) even among heavy drinkers.

The main opposition to per unit pricing of alcohol has always been that the heaviest drinkers won’t change their behaviour over price alone, and that there is no real evidence that pricing works in terms of health outcomes. This study is one of a growing body strongly suggesting otherwise. I suspect, with increasing pushes from police, health services and professionals, and the churches for minimum per unit alcohol pricing, it is only the alcohol industry itself that is really holding out against this policy.

It has certainly been something that CMF has supported in the past. Alcohol is one of the most potentially damaging drugs known, and it is freely available. Churches have seen the sharp end of what happens, especially in poorer communities where alcohol abuse is widespread; hence there is a long history of Christians campaigning against the damaging and pervasive influence of alcohol in society – from the eighteenth and nineteenth century temperance movements to more modern work in alcohol rehabilitation. We have long recognised that alcohol abuse damages social fabric, forces families into poverty, leads to violence and sexual abuses. And despite two centuries of activism and campaigning, we are seeing the same problems entrenched in British society in the twenty first century that wrecked the lives of the poor in Georgian and Victorian Britain.

Pricing alone is not the solution of course – as we and church groups have argued, you have to address the psychological and social roots of alcohol abuse as well. But the evidence is certainly stacking up that this is one tool that is having an impact.

Shinya Yamanaka of Kyoto University won the Nobel Prize in medicine this year for his pioneering work in producing induced pluripotent stem cells (iPS) from adult skin cells in mice.

In so doing he laid the framework for an ethical alternative to using embryonic stem cells (which involve the destruction of an embryo) to provide treatments for conditions including diabetes, Parkinson’s disease, spinal injury and ischaemic heart disease.Since his initial breakthrough in 2006 there have been progressive refinements of his technique (see here and here) and just last week, in a new breakthrough, a team at the University of Cambridge used cells from a patient’s own blood (‘late outgrowth endothelial progenitor cells’) to make personalised stem cells from which they will be able to grow blood vessels. The first use will be to test drugs on those vessels.This latest study was published in the journal Stem Cells: Translational Medicine.Dr Amer Rana, leading the team, said this method was better than taking samples from skin or other tissues because of the relative ease of obtaining a blood sample.The British Heart Foundation added that these cells had ‘great potential’ and The Medical Research Council talked of ‘rapid progress’ being made in the field.Whilst therapies derived from iPS cells are still some way off, the advances have been so dramatic that a review by Matt Ridley in the Wall Street Journal this week concludes:

‘It’s not far-fetched to conclude that, thanks to induced pluripotent stem cells, the embryonic stem-cell debate is fading fast into history. If stem cells derived from the patient’s own blood are to offer the same therapeutic benefits as embryonic stem cells, without the immunological complication of coming from another individual, then there would be no need to use cells derived from embryos.’

Ridley says that the chief medical ambition of those who study stem cells has always been that the cells would be used to repair and regenerate damaged tissue. But, he adds, there’s another, less well known application of stem cells that is already delivering results: disease modeling.

It might soon be routine to test drug treatments on personalised tissue created from your own stem cells in order to work out which drugs might best benefit your condition.

Ridley reports of a study doing just this. A team at Johns Hopkins University and the Sloan-Kettering Institute for Cancer Research, using a version of Dr Yamanaka’s technique, successfully grew nerve cells from a patient suffering from a rare disease called Riley-Day syndrome, which is linked to early mortality, seizures and other symptoms and caused by a fault in one gene.

The scientists then tested 6,912 chemical compounds on the cells to see if they could find one that ‘rescued’ the ‘expression’ of the gene: that is to say, caused it to produce the protein it is supposed to produce. One of the compounds worked, inducing the gene to be actively transcribed by the cell. Ridley concludes:

‘The hope is that in the not-very-distant future, when something is going wrong in one of your organs, one treatment may be to create some stem cells from your body in the laboratory, turn them into cells of that organ, or even rudimentary structures, and then subject them to experimental treatments to see if something cures the problem. The goal of personalized medicine, in other words, may be reached by stem-cell researchers before it’s reached by geneticists.’

In a further development this week along the same lines ten international drug companies are to team up with scientists from 11 European countries to create a bank of stem cells for a project aimed at speeding up the development of new medicines.

‘StemBANCC, coordinated by Swiss drugmaker Roche and managed by scientists at Oxford University, aims to use human-induced pluripotent stem cells (iPS) derived from people with hard-to-treat conditions – as research tools.

Martin Graf from Roche, who is coordinating the project, said the goal was to generate 1,500 induced pluripotent stem cell lines derived from 500 patients that can then be used by researchers around the world to study a range of diseases, including diabetes and dementia.

Graf and Zameel Cader of Oxford University, who announced the project in London, said the raw material for the project would be largely skin and blood samples taken from patients with diseases such as Alzheimer’s and diabetes.

The research will focus mainly on these conditions as well as peripheral nervous system disorders such as chronic and neuropathic pain, central nervous system disorders such as dementia, and neurodysfunctional conditions such as autism, schizophrenia and bipolar disorder.

One of Dr Yamanaka’s original motivations when he set out to induce pluripotency in adult cells was to discover ethical avenues of research. He once said:‘I thought, we can’t keep destroying embryos for our research. There must be another way.’

Even Julian Savulescu, the controversial and liberal bioethicist at Oxford University, recognises that Yamanaka has achieved great scientific advances within an ethical framework:

‘Yamanaka has taken people’s ethical concerns seriously about embryo research…he deserves not only a Nobel Prize for Medicine but a Nobel Prize for Ethics’.

The best and most effective treatments are also ethical treatments. Maybe that is the most important lesson to learn from all this.

Perhaps the last word belongs to leading US stem cell scientist James Sherley: ‘For those trained in the science, this is not news, but instead a completed fate that was known from the beginning’ – a timely reminder that in good science the end does not justify the means (Romans 3:8).

Posted by Dr Peter Saunders

CMF Chief Executive

]]>https://cmfblog.org.uk/2012/12/11/ethically-derived-stem-cells-offer-more-therapeutic-promise-exciting-new-breakthroughs/feed/0BBC article on ‘gay therapies’ is simplistic, misleading and ignores much of the available evidencehttps://cmfblog.org.uk/2012/09/24/bbc-article-on-gay-therapies-is-simplistic-misleading-and-ignores-much-of-the-available-evidence/
https://cmfblog.org.uk/2012/09/24/bbc-article-on-gay-therapies-is-simplistic-misleading-and-ignores-much-of-the-available-evidence/#respondMon, 24 Sep 2012 10:13:07 +0000https://www.cmfblog.org.uk/?p=5607Should people with unwanted feelings of same-sex attraction seek professional help? And if so what kind of help and what expectations should they realistically have?

I was asked to submit a quote for it yesterday but was unable to obtain any information about what angle the author would be writing it from. So I sent in four carefully drafted sentences of which they used only the one that most closely fitted with their agenda.

The article relates the story of Peterson Toscano, who ‘after $30,000 for controversial conversion therapy, three attempts at exorcism and one failed marriage, finally resolved the conflict between his faith and sexuality – he was gay’.

At the end there are some comments from Peter Ould and myself (see Peter’s take here)

Toscano’s case highlights the dangers of well-meaning Christians without proper professional training doing more harm than good in attempting to, in effect, ‘pray the gay away’.

But the article throws the baby out with the bathwater. Its fundamental flaw is to argue from the particular to the general, that is, because this man’s personal experience was negative therefore all attempts to help people with unwanted same-sex attraction are misguided and bad.

This conclusion is unwarranted and not actually supported by the available evidence.

I’m not going to comment on the individual case, but rather make some comments on the general issue.

There is first a huge amount of confusion both in the Christian church and in the world generally about the difference between homosexual attraction, orientation, identity and behaviour, which I attempt to address in my earlier blog, ‘Should gay Christians be true to their feelings?’

But there is even more confusion about what the media has unhelpfully branded ‘reparative therapies’.

The full quote I gave the journalist who wrote today’s BBC article read as follows:

‘Many people believe that homosexual and heterosexual are distinct biological categories which are unchangeable, biologically fixed and genetically determined but this view is being increasingly challenged by new research. Sexual attractions are now best understood as lying on a spectrum rather than in terms of a simple dichotomous binary categorisation, and mixed patterns of sexual desire, including attraction to both sexes at the same time and changes in the strength and direction of sexual attraction over time are not uncommon. It is on this basis that some people understandably will seek professional help in dealing with their changing feelings. Professionals providing such care should do so in a way that both respects the beliefs and values of the person seeking help and is also evidence-based.’

They chose only to use the last sentence, I suspect because the other three, about the fluidity of sexual feelings, did not fit with the underlying presupposition of the article that sexual orientation is something fixed, unchangeable and genetically determined and that the only approach to people experiencing feelings of same sex attraction is to encourage them to embrace a ‘gay lifestyle’.

But this view is overly simplistic and not actually supported by the evidence (see my article on Max Pemberton for more on this)

Instead the latest research supports the idea that, for some, sexual feelings are often quite fluid and changeable. Many gay rights commentators including Peter Tatchell and Matthew Parris share this view.

This leaves us then with the question of how to help those who are experiencing ‘unwanted’ feelings of same sex attraction.

The whole booklet is worthy of careful study but I have pasted part of the executive summary below which amplifies on what I said in my quote:

People with unwanted SSA who seek to live in conformity with their beliefs should be free to receive appropriate and responsible practical care and counsel. Most may choose counselling and pastoral support to maintain, within a Christian ethical framework, the disciplines of chastity. Others may wish to explore the possibility of achieving some degree of change in the strength or direction of unwanted sexual interests.

Experience of change in the strength or direction of one’s sexual interests is sometimes possible. Although the extent of such change will differ between individuals, what is commonly referred to as sexual ‘orientation’ is not invariably a fixed and enduring characteristic of the human condition, rooted in biological difference and experienced from birth. Whilst some people experience same-sex attraction from their earliest memories of sexual interest, for others sexual desire can be relatively fluid. There are many personal narratives of change of sexual ‘orientation’ reported in both the secular and religious media. When assessing counselling efforts that seek to promote ‘change’ in the strength, direction, or expression of same-sex desire, the entire range of human sexual experience must therefore be addressed rather than assuming all sexual attraction is always fixed.

No high quality scientifically controlled trials have been carried out on efforts to promote change in sexual ‘orientation’ and claims for or against the effectiveness of specific approaches must therefore be treated with caution. ‘Sexual Orientation Change Efforts’ have provoked passionate opinions on all sides. Various mental health bodies and professional associations have made negative declarations about their desirability and effectiveness. It has been asserted that there is ‘no evidence’ that efforts to promote change in sexual ‘orientation’ are effective. Such statements, if allowed to stand unqualified, are potentially misleading. Because no randomised controlled trials have been carried out in this area, it is not possible to assert conclusively whether efforts to promote ‘change’ are effective or whether they are not effective. There is no ‘cast iron’ evidence either way. A balanced and objective assessment would note there are many personal reports of change in sexual orientation from within both secular and religious cultures, but that there remains uncertainty about the effectiveness of any particular psychological or counselling approach designed to promote such change.

Health and counselling professionals must practice ethically by respecting the religious beliefs and convictions of their clients and exercising due care in distinguishing between fact and personal opinion.

Given the absence of conclusive, high quality, scientifically controlled trials, those offering formal counselling to people with unwanted SSA must exercise considerable caution. They must follow conventional ethical guidelines in terms of informed consent and show respect for client autonomy and self-determination. When counselling clients with unwanted SSA, harm could result from raising unrealistic expectations or claims that go beyond the available evidence.

Those with unwanted SSA who seek to live within the orthodox boundaries of Christian faith and ethical practitioners who support them deserve our honour, support and respect. Both groups should be free to act in accordance with their conscientious beliefs without harassment, misrepresentation or discrimination.

If you live in Wales, or plan to live – or study – there for longer than six months, by 2015 you are likely to find yourself automatically registered as an organ donor, whether you are fully aware of it or not. You will have to register specifically to opt out of this if you do not want to be on the organ donor list.

Yesterday the Welsh government closed a consultation on the drafting of a new bill to change the law on organ donation in Wales. The final version will be put before the National Assembly for Wales by the end of 2012 with the intention of a new law being passed by 2015.

The drive for this controversial change in the law is the demand for body organs for transplant, which far exceeds the organs available. There is a waiting list that is growing, and it is estimated that 500 people die each year while waiting for a transplant.

Clearly there is a problem. Providing organs for transplantation both saves and enhances life yet there are not enough to supply the needs of so many patients. So new ways are constantly being sought to increase donor numbers.

But that generates another problem because while some proposals and methods of increasing donation are uncontroversial and should be welcomed others are far more ‘ethically tricky’.

The Welsh Government has decided to go down one of the more controversial routes by drafting a Bill, now likely to become law, to introduce ‘deemed’ (ie. presumed) consent for organ donation.

If anyone living in Wales does not formally register that they want to opt out of donating their organs on death, they will be treated as consenting to donate. The default position will be for consent to be ‘deemed’ to have been given. I have argued elsewhere that this does not meet adequate standards of informed consent, and nor is it even necessary. Nevertheless, the Welsh Assembly is determined to go ahead with this.

However there is still time for some aspects of the Bill to be amended during the Assembly debates, otherwise we will end up in a situation where organs can be removed from dead patients without their active consent AND against the wishes of their family.

This then generates a further problem: where that leaves families.

Families of the deceased will be ‘sensitively encouraged to accept’ this ‘decision’ (if a ‘non-decision’ can be called a ‘decision’). The explanatory memo with the draft Bill states that: ‘…if there are very strong objections or distress [from the family], then organ donation is unlikely to go ahead. It is important to be clear, however, that this is not a legal veto because the law will recognise the deemed consent of the deceased as having precedence.’

Although the Welsh government has said all along that it will introduce soft opt-out legislation that would allow the deceased family a role in the final decision, the draft bill as it stands does not in fact allow for this. There is in fact NO provision in the draft Bill for family to veto the removal of organs from their loved ones. The accompanying memo concedes only that if there are very strong objections or distress, the taking of organs is ‘unlikely’ to happen. It does not state that it will not happen. Moreover, it says that the objections have to be ‘very strong’ or that family must be ‘very distressed.’

At the moment under the UK Human Tissue Act it is possible for a family to veto the removal of organs from someone who signed a donor card, or gave consent to donation in some other way consent made by a person to donate their organs, if the family have strong objections to donation. This is rarely used (at most with 10% of possible donations).

Why should a family be able to veto donation?

1. Increased distress. The Bristol and Alder Hey controversies were fuelled by the perception that families had no real power in decision-making with respect to what happened to their loved ones body parts. They also showed how crucially important the body is to bereaved parents and friends, and illustrated the need to respect the human body, even in death. It is not simply raw material.

There are occasional situations where continuing with donation will increase distress for a family at a tremendously difficult time. The decision about whether to donate has to be made quickly, and families might well find that they cannot agree to donate. If their wishes not to donate are then overridden, even if in accordance with the wish of the deceased to donate, this might well increase the distress families are already feeling.

2. Cultural sensitivity. Not all cultures are as individualistic or materialistic as the mainstream Western tradition, and in some cultures, individuals wishes do not override the family’s. In such situations it may well be culturally insensitive to insist that they do.

3. Lack of trust. Some people fear that if they became seriously ill, they would receive less thorough treatment if they were donors than if they were non-donors because doctors want their organs. This fear – which need not be well founded to have an effect – would increase if the family’s views were known to be overridden. People look to their families to protect them when they cannot protect themselves. Publicly overriding families could make people and their families feel more vulnerable to doctors skimping on their treatment and so more reluctant to donate.

Moreover, some donors will only consent to donation of certain organs (there may be concerns about the possibility of brain and gonad transplantation, for example) and so will look to their families to ensure that their specific wishes are carried out.

4. Concern about consent. It will be almost impossible to guarantee that everyone is informed and understanding of ‘deemed consent’, knows their options and can easily opt out. Can consent be truly assumed from those who are disorganised, apathetic, disabled, less well educated or informed, isolated, lacking full capacity, of different languages and race, suffering from (temporary) mental illness, dependent, those who have less ready access to information and those who change their minds? The importance of allowing families a veto in such cases is obvious.

5. Ownership of the body. Underpinning the proposed change in the law is a change in the relationship between the individual and the state. The assumption about whose body it is begins to move from personal ownership to state ownership. Unless the state wishes to suggest that the deceased now belongs to it, the family must have the right to become his/her spokesperson.

As we have always said, CMF is supportive of organ donation in principle. However we are not supportive of presuming consent when it has not been given, nor do we support overriding the family and the important role they should play. God designed human beings in His image to be relational (Gen 1:26,27, 2:18-25) and the Bible everywhere assumes the significance of the family. Kinship, family identity and family heritage are important biblical themes as this CMF File explains.

Let’s hope that Assembly members take on board these concerns and amend this controversial Bill so that it makes plain in law that where the deceased has not given express consent, clinicians should not be able to take organs if the family object. Welsh organ donation proposals must give more than lip-service to family veto.

I have just posted a blog on the report from a committee of MPs which makes recommendations about new measures to protect children from internet pornography.

Most of these are targeted at the ISP industry (and not a moment too soon!) but the real need is for parents to take steps themselves.

If you are interested about how practically to do it here is some advice from a Christian medical colleague (and computer whizz!) that I have gleaned today.

How to protect your kids (and yourself!)

Because of the proliferation of connectable devices having software just on a PC is inadequate – the entire home network needs internet filtering.

The best way to achieve this is for the ISP to do it. Out of the 4 main British ISPs (Virginmedia, Talktalk, BT and Sky) only Talktalk can do this at present.

The main system I use is ‘Covenant Eyes’. This is accountability software that I use with a friend. It monitors internet use and alerts your accountability partner if you are accessing inappropriate websites. Once installed it cannot be removed without your accountability partner being alerted. You probably know about this already but the website gives full details. It would be a brilliant thing to do with teenagers. Although there is little need for this if the OpenDNS service is used (see below), it has the advantage of monitoring a device whether it is used at home or elsewhere – OpenDNS only covers your home network.

Second, most mobile phone networks have the ability to turn on web filtering for smartphone use at a network account level. So as long as your kids have mobile phones on your account you can block the inappropriate use of mobile devices through the 3G network.

Third, and this is the really clever way of doing it, a home user can achieve network-wide site filtering by using a service called OpenDNS. A brief, simple explanation of what a DNS Server does can be found at the end of this post.

To set this up you have to create an account on OpenDNS.com, tell OpenDNS about the IP address your ISP has given your ADSL or cable modem, and then edit the settings in your router so you use OpenDNS’s DNS Servers rather than your ISP’s. They provide good instructions on how to do this, but it’s a little technical. The service is free. (There is a more feature-rich service that you have to pay for but for most home networks the free bit is all you need).

As long as you keep the usernames and passwords for both your router and your OpenDNS accounts completely secret there is generally no way past this, even for your bright computer-savvy kids.

Every networked device has a unique numerical address – an “Internet Protocol” (IP) address. It is a set of 4 numbers (between 0 and 255) separated by dots. The PC I am typing this on has the IP address “10.0.0.106”. My PC at work is “172.22.255.42”. When devices communicate over the network they talk to each other using these numerical IP addresses – but they are not very human-friendly! So each device also has a name – my PC is called onhealthy seroquel “Saturn”. At some point the IP address and the name need linking, so when I look at my network and see a PC on it called “Saturn” the software knows “Saturn” = IP address 10.0.0.106, and vice versa. This name to IP address translation is done through a database called “DNS” – “Domain Name Service”. Every device has to know the address of the computers on their network that hold the DNS database (there’s usually 2 – one main one and one backup). A computer holding the DNS is known as a DNS Server. With me so far? Good!

Now, this is also true on the Internet, with the condition that every device connected directly to the internet has to have a worldwide unique IP address. So the computer called “microsoft.com” (that responds when you type”www.microsoft.com” into your web browser) has the IP address “207.46.232.182” – no other computer exposed on the Internet can ever have this address. When you type “www.microsoft.com” into your browser your Internet router that connects you to the Internet realises no device inside your home network has this name so it sends out a request to your ISP’s DNS servers which will respond with “the IP address you need is 207.46.232.182”. Your router can then find this address on the Internet and you can see the Microsoft website. Every ISP provides all their users with the IP addresses of two DNS server so your router knows were to send the request for name to IP address translation to. For example, VirginMedia provides a primary DNS Server IP address of 194.168.4.100, and a secondary IP address of 194.168.8.100. Everyone using VirginMedia as an ISP will have these 2 IP addresses in the setup of their router so the network knows how to change website names into IP addresses.

A DNS server contains a huge database of website names and IP addresses – billions probably. Every single request to view a website that comes out of any device connected to your home network will go through the DNS server. Here comes the clever bit…

You don’t have to use the DNS servers provided by your ISP. For example Google has a couple of public ones that you can use – their IP addresses are 8.8.8.8 and 8.8.4.4. Program those IP addresses into your router instead of the ones provided by your ISP and all your IP address requests will go through Google’s DNS servers.

A company called “OpenDNS” provides 2 DNS server addresses for public use. They have built into them the ability to block certain website addresses from being passed back to your network. There is a massive classification database available that classifies millions and millions of websites into certain categories – hate, racist, violence, porn etc. The OpenDNS servers use this classification to allow you to filter website requests. So if I type “www.playboy.com” into my browser, VirginMedia’s DNS servers would return “67.215.65.130” and off I go into the Playboy website. OpenDNS (assuming I have an account with them and have set up the filtering to block porn) will refuse to return an address and say the site is blocked. As you will now understand, any device connected to my network (smartphone, PC, laptop, PS3, XBox etc be they mine or guests in my home) will get the same response – “blocked”.